Many elderly people visit the emergency department for various illnesses and conditions. Hospitals must make sure to keep them on the right track for a smooth recovery, because seniors may have a higher chance of experiencing complications than younger people do – especially after injuries like falls.
Plus, as the population ages, hospitals will have to deal with larger numbers of elderly patients, so clinical staff must attend to their unique needs, including any possible chronic conditions making the injury or illness that brought them to the ED more detrimental to their health.
Visits from elderly
New data from the Centers for Disease Control and Prevention shows just how many seniors are visiting the ED each year. The numbers came from the National Hospital Ambulatory Medical Care Survey and are based off hospital visits from 2012 through 2013.
In general, adults age 65 and over had an ED visit rate of 12 out of every 100 people for injuries and 36 out of every 100 people for illnesses. Elderly women had a higher ED visit rate for injuries, but there was no difference between women and men for illnesses. Only 17% of injury visits resulted in a hospital admission, compared with a 32% admission rate for illness.
When looking closely at ages, adults age 85 and over had the highest visit rates for the ED (25 out of 100 people due to injuries and 57 out of 100 people due to illness). Adults age 65 to 74 had ED visit rates of 9 out of 100 people for injuries and 29 out of 100 people for illnesses.
Effect of falls
One of the most common injuries that cause elderly patients to visit the ED is falls. As discussed in an article from Kaiser Health News, as patients live longer and take more medications for illnesses, they’re more vulnerable to experience symptoms (such as disorientation or dizziness) that make them prone to falling.
This problem is particularly evident in California, where ED visits due to falls are growing steadily. In 2010, there were 167,785 visits to the ED because of falls. By 2015, this number grew to 232,146. A third of these visits were for patients age 85 and older.
Fall injuries are costly to treat, racking up billions in hospital expenses. And they can also contribute to hospital readmissions. Patients being treated for hip fractures, a common injury occurring in seniors after falls, are more likely to develop conditions like pneumonia or blood clots.
In addition, falls can be signs of other problems that may not be apparent when the patient initially visits the ED, including serious heart problems and issues with blood pressure.
To best treat an elderly patient who visits the ED after a fall, it’s key for hospital staff to target both the underlying cause of the fall and any injuries occurring afterward.
According to an article from the Annals of Emergency Medicine (link courtesy of the Sinai EM Media Site), using the acronym CATASTROPHE can help providers determine whether a fall was an isolated incident, or a sign of a health problem that needs additional attention. The acronym stands for:
- Caregiver and housing (including information about the circumstances of the patient’s current fall and fall history)
- Alcohol (any use or withdrawal)
- Treatment (medications taken, as well as any drugs the patient started or stopped taking)
- Affect (depression or other signs of mental illness)
- Syncope (information about whether the patient’s fainted recently)
- Teetering (dizziness)
- Recent illness
- Ocular problems (e.g., blurred vision)
- Pain with mobility (including any joint pain or general pain)
- Hearing, and
- Environmental hazards (e.g., steps or rugs).
Keeping these factors in mind when assessing an elderly patient could help clinicians better pinpoint any latent problems contributing to the person’s fall, leading to a smoother recovery with fewer complications.
As more older patients visit the ED due to injuries like falls, having a similar screening process in place is crucial to directing them to the resources they need for the most effective treatment.